Skip to main content
SpringerLink
Log in

Pneumocystis pneumonia in brain tumor patients: risk factors and clinical features

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Summary

We reviewed the clinical features and risk factors for Pneumocystis carinii pneumonia (PCP) in patients with brain tumors (BTs) seen at our institution between 1980 and 1992. Previously rare, this opportunistic infection appears to be increasing among HIV-negative cancer patients receiving immunosuppressive medications. Recent reports have noted PCP among BT patients receiving corticosteroids, and suggested that these patients are particularly likely to develop PCP when corticosteroids are tapered.

Nine BT patients, eight with high-grade gliomas, experienced ten episodes of PCP None were known HIV-positive. All were on dexamethasone (DXM) at PCP onset, and had continuously been receiving it for 47–398 days (median 69). Daily DXM dose at PCP onset ranged from 1–16 mg (median 9). Five episodes occurred in patients receiving a stable DXM dose and five during DXM taper. Nine episodes occurred in patients receiving chemotherapy. All patients had absolute lymphopenia at PCP onset, ranging from 80–900 × 106 lymphocytes/l (median 222 × 106/l, normal > 1000 × 106). Three episodes were fatal despite appropriate antibiotic therapy.

Unlike others, we did not find that corticosteroid taper predisposed to developing PCP As in HIV, PCP in BT patients appears related to lymphopenia, in these patients attributable to use and duration of corticosteroids and in some cases cytotoxic chemotherapy. Effective prophylaxis exists and should be considered for lymphopenic patients and those requiring DXM for > five weeks.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Varthalitis I, Aoun M, Dancau D, Meunier F: Pneumocystis carinii pneumonia in patients with cancer. Cancer 71: 481–485, 1993

    Google Scholar 

  2. Hughes WT: Pneumocystis carinii pneumonia. In: Gorbach SL, Bartlett JG, Blacklow NR (eds) Infectious Diseases, W.B. Saunders, Philadelphia 494–497, 1992

    Google Scholar 

  3. Henson JW, Jalaj JK, Walker RW et al.: Pneumocystis carinii pneumonia in patients with primary brain tumor. Arch Neurol 48: 406–409, 1991

    Google Scholar 

  4. Sepkowitz KA, Brown AE, Telzak EE et al.: Pneumocystis carinii pneumonia among patients without AIDS at a cancer hospital. JAMA 267: 832–837, 1992

    Google Scholar 

  5. Slivka A, Wen PY, Shea WM, Loeffler JS: Pneumocystis carinii pneumonia during steroid taper in patients with primary brain tumors. Am J Med 94: 216–219, 1993

    Google Scholar 

  6. Godeau B, Coutante-Perronne V, Huong DLT et al.: Pneumocystis carinii pneumonia in the course of connective tissue disease: Report of 34 cases. J Rheumatol 21: 246–251, 1994

    Google Scholar 

  7. Kovacs JA, Hiemenz JW, Macher AM et al.: Pneumocystis carinii pneumonia: A comparison between patients with the acquired immunodeficiency syndrome and patients with other immunodeficiencies. Ann Int Med 100: 663–671, 1984

    Google Scholar 

  8. Peters SG, Prakash UBS: Pneumocystis carinii pneumonia: Review of 53 cases. Mayo Clin Proc 82: 73–78, 1987

    Google Scholar 

  9. Chechani V, Bridges A: Pneumocystis carinii pneumonia in patients with connective tissue disease. Chest 101: 375–378, 1992

    Google Scholar 

  10. Porter DR, Marshall DAS, Madhok R et al.: Pneumocystis carinii infection complicating cytotoxic therapy in two patients with lymphopenia, but a normal total white cell count. Br J Rheumatol 31: 71–72, 1992

    Google Scholar 

  11. Frenkel JK, Good JT, Shultz JA: Latent Pneumocystis infection of rates, relapse, and chemotherapy. Lab Invest 15: 1559–1577, 1966

    Google Scholar 

  12. Walzer PD, Powell RD Jr, Yoneda K et al.: Growth characteristics and pathogenesis of experimental Pneumocystis carinii pneumonia. Infect Immunol 27: 928–937, 1980

    Google Scholar 

  13. Masur H: Prevention and treatment of Pneumocystis pneumonia. N Engl J Med 327: 1853–1860, 1992

    Google Scholar 

  14. Phair P, Munoz A, Detels R et al.: The risk of Pneumocystis carinii pneumonia among men infected with human immunodeficiency virus type 1. N Engl J Med 332: 161–165, 1990

    Google Scholar 

  15. Task Force Recommendations (Recommendations for prophylaxis against Pneumocystis carinii pneumonia for adults and adolescents with Human Immunodeficiency Virus). MMWR 41: 1–11, 1992

    Google Scholar 

  16. Fauci AS, Dale DC, Balow JE: Glucocorticoid therapy: Mechanism of action and clinical considerations. Ann Int Med 84: 304–315, 1976

    Google Scholar 

  17. Masur H, Lane HC, Kovacs JA et al.: Pneumocystis pneumonia: From bench to chair. Ann Int Med 111: 813–826, 1989

    Google Scholar 

  18. Slade JD, Hepburn B: Prednisone-induced alterations of circulating human lymphocyte populations. J Lab Clin Med 101: 479–487, 1983

    Google Scholar 

  19. Walzer PD, Labine M, Redington TJ, Cushion MT: Lymphocyte changes during chronic administration of and withdrawal from corticosteroids: Relation to Pneumocystis carinii pneumonia. J Immunol 133: 2502–2508, 1984

    Google Scholar 

  20. Zweiman B, Atkins PC, Bedard P-M et al.: Corticosteroid effects on circulating lymphocyte subset levels in normal humans. J Clin Immunol 4: 151–155, 1984

    Google Scholar 

  21. Hughes WT, Kuhn S, Chaudhary S et al.: Successful prophylaxis for Pneumocystis carinii pneumonitis. N Engl J Med 297: 1419–1426, 1977

    Google Scholar 

  22. Hughes WT, Rivera GK, Schell MJ et al.: Successful intermittent prophylaxis for Pneumocystis carinii pneumonia. N Engl J Med 316: 1627–1632, 1987

    Google Scholar 

  23. Wilber RB, Feldman S, Malone WJ et al.: Chemoprophylaxis for Pneumocystis carinii pneumonia: Outcome of unstructured delivery. Am J Dis Child 134: 643–648, 1980

    Google Scholar 

  24. Lawson DH, Jick H: Adverse reactions to co-trioxazole in hospitalized medical patients. Am J Med Sci 275: 53–57, 1978

    Google Scholar 

  25. Lawson DH, Paice BJ: Adverse reactions to trimethoprim-sulfamethoxazole. Rev Inf Dis 4: 429, 1982

    Google Scholar 

  26. Rubin RH, Swartz MN: Trimethoprim-sulfamethoxazole. N Engl J Med 303: 426–432, 1980

    Google Scholar 

  27. Bozzette SA, Finkelstein DM, Spector SA et al.: A randomized trial of three antipneumocystis agents in patients with advanced human immunodeficiency virus infection. N Engl J Med 332: 693–699, 1995

    Google Scholar 

  28. Hardy WD, Feinberg J, Finkelstein DM et al.: A controlled trial of trimethoprim-sulfamethoxazole or aerosolized pentamidine for secondary prophylaxis of Pneumocystis carinii pneumonia in patients with the acquired immunodefieciency syndrome. N Engl J Med 327: 1842–1848, 1992

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Neuro-Oncology, Department of Neurology, Mayo Clinic and Mayo Foundation, USA

    David Schiff

Authors
  1. David Schiff
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schiff, D. Pneumocystis pneumonia in brain tumor patients: risk factors and clinical features. J Neuro-Oncol 27, 235–240 (1996). https://doi.org/10.1007/BF00165480

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00165480

Key words

Search

Navigation